Provider Demographics
NPI:1427599141
Name:PIOMELLI, ELIZA (MS)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:PIOMELLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:ALICIA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE DEPT 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1275
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:6350 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8605
Practice Address - Country:US
Practice Address - Phone:423-587-7337
Practice Address - Fax:423-586-0614
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid